Basic Information
| Provider Information | |||||||||
| NPI: | 1811419203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAINWRIGHT | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 840 S WOOD ST | ||||||||
| Address2: | CLINICAL SCIENCES NORTH 440, M/C 718 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129964242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 840 S WOOD ST | ||||||||
| Address2: | CLINICAL SCIENCES NORTH 440, M/C 718 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606124325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129964242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2017 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036156731 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 271799 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 036156731 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.